Program for Prevention and Control of Hepatitis B Cree Région

Program for Prevention and
Control of Hepatitis B
Cree Région
JULY 1995
Christina Smeja, consulting physician
Elizabeth Robinson, community health physician
Public Health Module, Cree Région of James Bay
Montréal General Hospital
Updated June 1997

Table of Contents
1. Objective ................................................... 1
2. Definitions .................................................. 1
Serologic and Clinical Patterns of Hepatitis B Infection ................ 2
3. Introduction ................................................ 3
3.1 Course of Disease .................................. .. ... 3
3.2 Epidemiology in Canada and among the James Bay Cree ......... 4
3.3 Prophylaxis for HBV Infections ............................. 4
3.4 Regional Activities for Prevention of HBV Infections ............ 5
4. Detection of HBsAg in Pregnant Women ........................ 6
5. Immunization of the Newborns of HBsAg Carriers ................ 6
Vaccination Schedule Proposed for Children 0-5 Years Old, If the
Mother is a Hepatitis B Carrier (HBsAg (+)). (All villages) .... ........ 7
6. Universal Vaccination for 4th Graders ...... .... ................ 8
7 . Vaccination against Hepatitis B for Waskaganish Infants .......... 8
Schedule of Routine Immunizations Recommended for Waskaganish
Infants ............................ .. ....................... 9
8. Epidemiological Follow-Up for HBV Infections ................... 10
8.1 Reporting HBV Infections ................................. 10
8.2 Epidemiological Survey ................................... 10
8.3 Serologic Tracking of Contacts ............................. 10
8.4 Preventive Measures for Contacts ........................... 11
8.5 Immunization for Unvaccinated Contacts of Subjects with
Acute Hepatitis B ......................................... 11
8.6 Immunization for Unvaccinated Contacts of a Chronic HBsAg
Carrier ................................................. 11
9. Post-Exposure Immunization .................................. 12
10. Pre-Exposure Prophylaxis for High-Risk Subjects ................. 12
References ....................................................... 13
Hepatitis B Program i

Appendice 1 Section 7.6 du PIQ, 2
e
édition, Avril 1995
Section 9.1 du PIQ, 2
e
édition, Avril 1995, p. 9.10 et 9.14 (PIQ
might be available in English in 1996)
Appendice 2 Questionnaire épidémiologique pour les cas d'hépatite B
(HBV)
Appendice 3 Pamphlet "How can Hepatitis B be prevented?"
ii Hepatitis B Program

1. Objective
To prevent the spread of hepatitis B among the population of the Cree
communities.
2. Définitions
HBV Hepatitis B virus. Transmitted by blood, sperm, vaginal secretions and
other biological fluids. This virus has three major antigens (markers):
HBsAg, HBeAg, and HBcAg. There are specific antibodies against each
of these antigens.
HBsAg Surface antigen. Detectable in the serum of a person infected with HBV
60 days after exposure. Persistence of HBsAg in the serum 6 months
after infection is the sign of a chronic carrier. Any serum containing
HBsAg is considered infectious.
HBeAg E antigen. Presence of HBeAg is associated with viral replication and
shows that the serum is very infectious.
HBcAg Nucleocapsidic antigen. HBcAg cannot be measured in the serum.
Rather, it is the antibodies against this antigen which are clinically
useful.
Anti-HBs Antibody against the surface antigen. It appears in the serum after
clinical cure and confers longlasting immunity. Its quantity will vary
after vaccination.
Anti-HBc Antibody against the nucleocapsidic antigen. It appears in all HBV
infections and persists long term.
Anti- Antibody whose presence indicates a recent HBV infection. HBc IgM
HBc-IgM
Anti-Hbe Antibody against the e antigen. Indicates the absence of viral replication
and a lower (but not zero) level of infection of a serum containing
HBsAg.
The following chart shows the serologic and clinical patterns of three types of HBV
infection: acute hepatitis, asymptomatic infection, and the chronic carrier state.
Hepatitis B Program 1